Inspection on 15/11/05 for Beech Haven

This inspection was carried out on 15th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Beech Haven 09/05/07

Beech Haven 17/01/07

Beech Haven 29/08/06

Beech Haven 10/05/05

Beech Haven 17/08/04

Beech Haven 26/04/04

Beech Haven 08/09/03

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Beech Haven 15-19 Gordon Road Ealing London W5 2AD Lead Inspector Sarah Middleton Unannounced Inspection 15th November 2005 12:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Beech Haven DS0000027723.V260516.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Beech Haven DS0000027723.V260516.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Beech Haven Address 15-19 Gordon Road Ealing London W5 2AD Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0208 991 0658 0208 997 3146 Mrs Phaik Choo Scarman Mr John Scarman Mrs Phaik Choo Scarman Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability over 65 years of age (0) of places Beech Haven DS0000027723.V260516.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include OP and MD(E) not to exceed 30 persons Date of last inspection 10th May 2005 Brief Description of the Service: Beech Haven is a private care home for thirty older people. It was first registered in 1986 under the Registered Homes Act 1984. The Registered Providers are Mr and Mrs Scarman and Mrs Scarman is the Registered Manager. Currently the home is registered for Older People only, although there are service users living in the home who have symptoms of Dementia and confusion. The home is three large attached houses in a residential area near Ealing Broadway. The home is accessible to shopping facilities and local amenities. Public transport is easily accessible, either by rail, tube or road. The accommodation consists of thirty single bedrooms, which are on three floors. There is a large lounge/dining room that is equipped to comfortably accommodate all the service users for their meals. The lounge overlooks an attractive well-maintained enclosed garden to the rear of the home. The main kitchen is off the dining room. There is a second lounge situated at the entrance of the home. The service users use this as a quiet area to see visitors and for review meetings. There are adequate bathroom facilities on each floor. There is a passenger lift that goes to the second floor and ramps to access the home and garden. To the front of the home there are parking spaces for several cars. Beech Haven DS0000027723.V260516.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out as part of the regulatory process. A total of almost four hours, 12.15pm- 4pm was spent on the inspection process. The Inspector carried out a tour of the home and inspected service user plans, staff files and maintenance records. Two service users and two staff were spoken with during the inspection. Some of the previous requirements had been met and several new requirements were set following this inspection. The home has ensured they do not admit any prospective service user who is potentially outside of their registration category and this must continue to ensure the home can successfully meet the needs of the service users. What the service does well: What has improved since the last inspection? The home has made some improvements in looking at their internal systems, for example staff training and how this is recorded. It continues to look at ways to improve the home on an ongoing basis. The recruitment systems are more robust since the last inspection with the Registered Provider/Manager ensuring all necessary checks have been carried out. The home monitors health and safety issues within the home and is aware of the need to balance risk against choice. This is with particular reference to the service users who choose to have their bedroom doors open, as this can only occur if the doors are fitted with appropriate door releasing equipment. The home is seeking to fit all fire doors with suitable door releasing equipment, if they are to be kept open. Beech Haven DS0000027723.V260516.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Beech Haven DS0000027723.V260516.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beech Haven DS0000027723.V260516.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&4 Service users are assessed prior to admission to ensure the home can meet their needs. Documentation must be forwarded to the CSCI regarding the service users with dementia to ensure the home can demonstrate how they meet the specific needs of the service users and to ensure the service users are reflected in the home’s registration category. Furthermore the home must confirm in writing if they are to offer a prospective service user a place to live in the home. This is in order to ensure the home has assessed the service user’s needs and is confident they can meet those needs EVIDENCE: Pre-admission documentation was seen on two recent admissions and one prospective service user. These provide a picture of service users needs, to include any health or mobility issues. Where possible the Registered Manager also seeks assessments from the relevant professional to ensure the home has sufficient information to make a decision regarding the service user. Beech Haven DS0000027723.V260516.R01.S.doc Version 5.0 Page 9 Currently there are four service users who have a formal diagnosis of dementia. These service users have lived in the home for some time and the home feels confident that they can meet their individual needs at this point in time. The documentation the Registered Manager must complete to ensure these particular service users are reflected in the homes registration category has not been completed. This must be done to ensure the home has fully considered how they can meet the needs of a small group of service users with these specialist needs. This is a re-stated requirement. The Registered Manager had been verbally informing prospective service users and their representatives if they were to be offered a place in the home. Confirmation of a place must be put in writing to the service user/their representative. This is a requirement. Beech Haven DS0000027723.V260516.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 9 Some aspects of service users needs had been identified and were being met. However there were shortfalls in identifying/documenting health needs. This must be completed to ensure the home has considered how they can meet these needs. Service users and/or their representatives must be involved when care plans are devised or reviewed, so that they have contributed their views regarding their specific plan. Furthermore risk assessments must be completed on all service users to ensure staff are aware of potential hazards. The medication systems in the home are robust and protect service users health and safety. EVIDENCE: Individual service user plans were available and samples were viewed. These outlined current needs of the service user to include their social, emotional and physical needs. There was no evidence that the senior who had completed the care plans had consulted with service users or their representatives when devising or updating the care plans. This is a re-stated requirement. Beech Haven DS0000027723.V260516.R01.S.doc Version 5.0 Page 11 Furthermore although two care plans had a manual handling risk assessment there was no evidence that general risk assessments had been completed on areas such as falling, pressure sores, or other relevant potential risks. This is a requirement. Clinical notes were viewed when a service user had seen a health professional. However individual health needs were not clearly outlined on the care plans inspected. The care plans did not document how specific health needs would be addressed by the home. If service users had made choices not to see a particular health professional, there was no indication as to how the home would meet their duty of care. This is a requirement. Samples of the medication administration records were inspected. These were completed correctly. Medication was stored in a safe and secure place. Eye drops stored in a fridge had a date of opening on it. The home has one service user on a controlled drug; this is stored in a separate metal locked box. A controlled drugs register records when this particular medication has been administered. A second member of staff witnesses this. This medication was counted and was correct at the time of the inspection. Staff confirmed they had received medication training. The home has encouraged staff to complete a long distance learning course on medication. Several staff are in the process of completing this course. In addition, the Registered Manager is arranging with the local Pharmacist to visit the home and run an update on medication issues for all staff to attend. Staff administering medication are supervised and monitored by the Registered Manager regularly to ensure they are following procedures and guidelines. Beech Haven DS0000027723.V260516.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 & 15 Social activities are in place and aim to provide stimulation and occupation for those service users wanting to engage in various sessions. Overall these are offered on a daily basis during the week and encourage service users to interact with each other. Visiting times are flexible and promoted for service users to maintain contact with family and friends. Meal provision and mealtimes are well managed and seek to offer choices for service users. Fresh food is on offer daily to offer a well balanced diet to service users. EVIDENCE: The home has several external people who visit the home and offer a range of activities. During the inspection a person was seen doing exercises with service users and offering them painting. They have been coming to the home for almost ten years and aim to provide various activities to stimulate those service users who agree to participate in activities. Those working in the church also visit the home on a regular basis to offer religious services and support. Beech Haven DS0000027723.V260516.R01.S.doc Version 5.0 Page 13 Several service users can go out into the community unaccompanied and might visit the local shops. One service user spoken with stated where possible they like to go out on their own and to be as independent as possible. Other service users attend Age Concern groups. The home is currently looking into improving their activity chart and making it more service user friendly and accessible, so that all service users are aware of the activities taking place each day. Relatives and friends were seen visiting service users during the inspection. A service user spoken with said they were able to have people visit them whenever they wanted. Menus were available and reflected choices. Meals are recorded for each service user on the daily contact sheets. Service users can have meals in their bedrooms, but staff aim to encourage service users to meet and sit with others for at least some part of the day. The kitchen was inspected and was found to be clean and tidy. Food that had been opened/prepared had dates of opening on them. Fridge temperatures had been taken on a daily basis and were within an appropriate range. Service users spoken with stated the food was very good. Beech Haven DS0000027723.V260516.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The home records and takes action regarding complaints made to the home. Service users were aware of who to complain to and that their concerns would be listened to and acted on. Systems were in place for the protection of vulnerable adults. EVIDENCE: Complaints records were viewed. There had been no complaints recorded since the last inspection. The CSCI had not directly received any complaints. Service users asked said they would speak to the Registered Manager if they had any concerns or complaints. Some staff had been completing a long distance learning course on adult abuse. Staff had several stages to work through and had to complete questionnaires and tests in order to pass this course. In addition staff look at adult protection issues when they study NVQ courses. Those staff asked, were aware of what action to take should they witness an incident. There have been no protection of vulnerable adult, (POVA) investigations since the last inspection. Beech Haven DS0000027723.V260516.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24 & 26 Overall the environmental standard of the home is high in most areas of the home. Thus providing a homely environment for service users. The malodour on the first floor near to one bedroom must be addressed to provide a pleasant home for service users and visitors. Communal areas offer sufficient space for service users to spend time alone or with others. Bedrooms were personalised and offered service users space to keep some of their own possessions. Staff must receive training and information on infection control to ensure staff are informed of this subject and follow appropriate procedures. EVIDENCE: A tour of the home was carried out and a sample of rooms viewed. These were being maintained satisfactorily. The vacant bedrooms had been decorated ready for new service users. Beech Haven DS0000027723.V260516.R01.S.doc Version 5.0 Page 16 The home replaces items and furnishings on an as and when basis. Overall the home is bright, tidy and well cared for. The garden is kept tidy and offers additional space for service users, weather permitting. There are two lounges. One is very large and encompasses the dining area. This is a bright and sunny room where service users can listen to music or watch television. Activities take place in this room. The assisted bathrooms and toilets viewed were satisfactory and sufficient in number. One service user agreed to show the Inspector their bedroom. This was spacious, clean and bright. The service user said their room was regularly cleaned and they had been able to purchase some small items of furniture to store their belongings. A key is offered to service users and it is noted on their care plans if they do or do not choose to lock their rooms. Protective clothing is provided in the home and used where necessary. The laundry room viewed was clean and appropriate to minimise the risk of infection. Service users said they were happy with the laundry facilities in the home. Staff spoken with had not recently received training on infection control. This is a requirement. A malodour was identified in a small area on the first floor. A requirement was made that this must be addressed through assessing if alternative/new flooring is needed or cleaning the floor to eradicate the smell. Beech Haven DS0000027723.V260516.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29 & 30 The provision of in house training and NVQ courses equip staff to meet the needs of individual service users. Overall the systems for the recruitment of staff were robust and safeguarded service users. EVIDENCE: The majority of staff have either studied an NVQ course, level 2 or are in the process of completing the course. The Registered Manager and a senior member of staff have recently begun studying for the NVQ level 4. The home encourages staff to gain NVQ qualifications and most of the staff team are keen to complete these courses. The sample of staff employment files viewed contained details of the applicants completed application forms, Criminal Record Bureau checks, medical declarations and two references. There was written evidence of staff induction training programmes and the courses staff had attended. One member of staff described how they shadowed staff and observed them before working alone. The Registered Manager is keen for all staff to attend training on dementia to ensure the home can meet the needs of those service users who have this condition. Beech Haven DS0000027723.V260516.R01.S.doc Version 5.0 Page 18 There is a new system in place that monitors the training staff have attended in order to keep staff up to date with the skills and knowledge they need to meet the needs of the service users. Staff confirmed they received regular training and they felt there were sufficient opportunities to develop on existing skills and develop new skills. Beech Haven DS0000027723.V260516.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 36 & 38 The home is well managed and the Registered Providers/Manager has a visible presence in the home. Quality assurance systems need to be more detailed with a summary of findings available for Inspectors and service users in order to demonstrate where areas of care need improving and where areas work well in the home. Staff receive regular supervision and support to ensure they are performing sufficiently in their role and meeting the needs of the service users. Water temperatures must be taken in all areas of the home to ensure the home safeguards service users health and safety. Other health and safety records were in place to protect service users. Beech Haven DS0000027723.V260516.R01.S.doc Version 5.0 Page 20 EVIDENCE: Service users and staff spoken with commented on the fact that the Registered Manager manages the home well and has a visible presence in the home. They are keen to learn and develop new ideas to improve standards in the home. It had been identified at the last inspection that the home must carry out a review of the quality of care offered in the home. This has not been carried out and a system for reporting any reviews had not been developed. Various areas within the home are assessed and some areas needing attention have been addressed. The home has begun to send questionnaires to professionals and this along with consulting with service users and their representatives must be carried out and included in the annual report of the reviews the home has undertaken. This is a requirement. The home has introduced more formal one to one staff supervisions to offer guidance and support to staff. Recently records have been kept on the computer. However it is strongly recommended that a supervision agenda is developed and supervision records are copied for both the supervisor and supervisee. Staff asked stated they receive regular and informative supervision and that they can take any issues they might have to these sessions. Servicing records were viewed at random. Those viewed for example, nurse call system, fire equipment, the testing for Legionella and the passenger lift were all up to date. Fire drills are held regularly, at different intervals and with different members of staff. The home has been recently using in house fire training that involves viewing information on a CD on the computer. It is strongly recommended the Registered Manager consult with the local London Fire & Emergency Planning Authority to ensure this form of training is sufficient. Water temperatures had been taken of communal bathrooms but not in service users bedrooms where there are sinks in each room. It is a requirement that all areas where service users or staff have access are regularly checked. Fire doors were closed during the inspection. The home is looking into fitting some doors with appropriate door closing devices, as many service users like to spend time in their bedrooms with the door open. The home is aware that doors must not be propped open. Beech Haven DS0000027723.V260516.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 x x 3 x 2 STAFFING Standard No Score 27 x 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 3 2 x x 3 x 2 Beech Haven DS0000027723.V260516.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP4 Regulation 14 Requirement Service users living in the home must accurately reflect the category of registration. (Previous timescale 10/05/05 not met) The Registered Person must confirm in writing to the prospective service user that the home can offer them a place. The Registered Person shall consult with the service user or their representative when devising or updating the individuals care plan. (Previous timescale 01/07/05 not met). The risk assessments for service users must be completed and reviewed on a regular basis. (Previous timescale 01/06/05 not met) There must be clear evidence that service users health needs are addressed and the treatment they receive must be recorded. Timescale for action 30/12/05 2. OP4 14 (d) 30/12/05 3. OP7 15 30/12/05 4. OP7 13 (4) 30/12/05 5. OP8 12(1)(a) &13(1)(b) 30/12/05 Beech Haven DS0000027723.V260516.R01.S.doc Version 5.0 Page 23 6. OP26 16 (2) (k) 7. 8. OP26 OP33 18(1)(c) (i) 24 9. OP38 13 (4) (a) (c ) Systems must be in place to manage malodours, (in reference to the 1st floor). Where identified as the case, flooring must be made good or replaced. Infection control training must be available for all members of staff. A review of the quality of care must be carried out. A copy of the report of findings must be forwarded on to the CSCI. (Previous timescale 01/08/05 not met) Water temperatures must be taken and recorded, in all areas where service users have access, e.g their bedroom hand basins. 30/11/05 01/03/06 01/03/06 30/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP36 OP38 Good Practice Recommendations It is recommended that in supervision an agenda is made to ensure staff receive support and guidance in all areas of their work. It is strongly recommended the Registered Manager consult with the London Fire & Emergency Planning Authority to ensure the fire training the home offers to staff is sufficient to ensure they have the skills and knowledge to respond appropriately in the event of a fire. Beech Haven DS0000027723.V260516.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection West London Area Office 58 Uxbridge Road Ealing London W5 2ST National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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